Acute Pancreatitis With Normal Amylase and Lipase: A Diagnostic Dilemma.

Acute pancreatitis is a common and potentially life-threatening condition. It is characterized by inflammation of the pancreas, most often leading to elevated levels of pancreatic enzymes in the blood. In a subset of patients, however, conventional biomarker levels may remain within the reference range. Such instances have the potential to create a diagnostic challenge for healthcare professionals and can lead to misdiagnosis or delayed treatment. This article presents the intriguing clinical scenario of acute pancreatitis with normal amylase and lipase, discusses factors that may lead to normoenzymatic presentation, and reminds clinicians of the diagnostic criteria for acute pancreatitis, which does not necessarily require elevated pancreatic enzymes.

Misleading Presentation: Chest Pain Masking Euglycemic Diabetic Ketoacidosis Possibly Induced by Empagliflozin.

Diabetic ketoacidosis (DKA) is a life-threatening metabolic emergency traditionally associated with Type 1 diabetes but is increasingly recognized in Type 2 diabetes, particularly with the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Euglycemic DKA, characterized by near-normal blood glucose levels, is a distinct variant that has gained attention. This case report highlights a unique presentation of euglycemic DKA in a 56-year-old female with a past medical history of Type 2 Diabetes Mellitus who presented to the emergency department with a one-week history of chest pain.

A Case of Colchicine Toxicity Presenting With Euglycemic Diabetic Ketoacidosis.

Colchicine has a narrow therapeutic window and a high risk of toxicity when co-administered with CYP3A4 inhibitors and P-glycoprotein inhibitors. Colchicine toxicity is associated with various metabolic disturbances and can cause multiorgan failure and death. However, to our knowledge, there are no documented reports of colchicine toxicity initially presenting as euglycemic diabetic ketoacidosis (DKA). We present a case of colchicine toxicity with concomitant euglycemic DKA in a man with long-term colchicine use who was also prescribed clarithromycin and dapagliflozin.

A Literature Review of the Therapeutic Perspectives of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitor-Induced Euglycemic Diabetic Ketoacidosis.

Euglycemic diabetic ketoacidosis (DKA), a side effect of sodium-glucose cotransporter-2 (SGLT2) inhibitors, is a triad of high metabolic anion gap acidosis, raised serum and urine ketones, and serum glucose <250 mg/dl. SGLT2 inhibitors cause a carbohydrate deficit by glucosuria, which leads to an increased glucagon/insulin ratio, the metabolic shift from glucose to lipid utilization causing ketogenesis, and hence euglycemic DKA. Additional factors like the ketogenic diet, illness, surgery, and pregnancy contribute to precipitating these episodes. Keywords search included "Euglycemic DKA and SGLT2 inhibitors" in PubMed and Google Scholar, to compile data from existing articles that provide information on the withholding and restarting period of the drug after a euglycemic DKA episode. SGLT2 inhibitors, used in the treatment of type 2 DM, have an average half-life of 11-13 hours, so most articles suggested withholding the drug three days before any elective surgery but some articles suggested a longer withholding period based on other precipitating factors contributing to euglycemic DKA. Hence, we came up with patient inclusion criteria and concomitant therapies review that we need to consider in making this decision. In addition, a multidisciplinary approach is required when laying out guidelines for restarting the drug to have a unanimous approach. After reviewing the existing literature, it is clear that concrete guidelines are required to decide on drug withholding and restarting periods after a euglycemic DKA episode, as they vary among different institutions and different specialties. We believe it is crucial to consider patient inclusion criteria and concomitant therapies in forming those guidelines.